The National Patient Safety Agency: falls in hospitals and mental health units

byFrancesonJuly 23, 2010

When the NPSA released Slips trips and falls in hospital in 2007, we began to fill a vacuum left by the 2004 NICE guideline on The assessment and prevention of falls in older people, which specifically excluded hospital settings. The NPSA is the leading voice for patient safety in the UK, and although creating a specific and detailed clinical guideline was outside our remit, in Slips trips and falls in hospital the NPSA pointed people towards the small but growing amount of research specific to hospital settings.
We were also able to tell the story of hospitals and mental health units who had implemented successful falls prevention programmes, and debate some of the more contentious aspects of the evidence, including the use of numerical risk scores.

The research and improvement stories were combined with analysis of the more than 200,000 falls reported to the NPSA during 2005/06, in the hope of highlighting to policy makers, healthcare staff, patients and the public the human cost of falls in hospital. The 200,000 falls reports certainly did get used to help raise awareness; my favourite finding from an evaluation of the report was a nurse director who said “I love quoting the figures – they make people go ‘ooooh.’” But with repetition and the passage of time, numbers lose their original impact.Because of this, the NPSA has released updated data to coincide with National Falls Awareness week. As the NPSA’s national reporting and Learning System has matured, we have access to much more comprehensive and reliable data, and this is reflected in the headline figure of over 280,000 falls and almost 1,000 hip fractures (61% of the fractures) reported from hospitals in England and Wales each year.

The data also show the degree to which falls affect the oldest and most vulnerable of our patients – more than a third of falls are in patients aged over 85 years. And the data raises questions, too – why a late morning peak for falling? Are the lowest reporting hospitals on the benchmark graphs exemplars of falls prevention or perhaps reflect organisations where staff feel so powerless to prevent falls they no longer trouble to report them?

Other things have changed since 2007. There is no longer a vacuum of resources for preventing falls in hospitals. In the UK the Royal College of Physicians Falls and Bone health audit expanded to include falls prevention in hospitals and the NPSA collaborated with the NHS Institute for Innovation and Improvement and the Healthcare Foundation to produce the Patient Safety First ‘How to’ Guide for Reducing harm from falls. Falls in hospital are one of the Department of Health’s nurse-sensitive metrics and one of the High Impact changes for nursing and midwifery, and many more regional and local initiatives are underway. Internationally there is much to learn from, including the Australian guidelines focused on hospital falls prevention. The current challenge is fitting together this range of advice and resources in practice, and the NPSA in partnership with ProFaNE aims to make this easier. Published evidence relevant to falls prevention in hospitals has been brought together on the ProFaNE website. The NPSA has sponsored a new ProFaNE discussion board dedicated to falls prevention in hospitals, where you can raise questions or challenges specific to inpatient settings and receive advice and support from the ProFaNE community. We hope to build up over time collections of resources from individual hospitals that can be taken and adapted by others – we are starting with a call for copies of protocols for aftercare following a fall in hospital.

The ProFaNE areas will link to the NPSA’s Patient Safety First website, which is working towards becoming a onestop shop linked to all other relevant initiatives. Most importantly, we aim to collect your stories of improvement from the frontline so others can learn from them - any offers via email to frances.healey@npsa.nhs.uk or via the ProFaNE discussion board gratefully received!